P915: TREATMENT PATTERNS AND CLINICAL OUTCOMES OF PATIENTS WITH MULTIPLE MYELOMA PREVIOUSLY TREATED WITH LENALIDOMIDE AND AN ANTI-CD38 MONOCLONAL ANTIBODY: FINDINGS FROM THE CONNECT MM DISEASE REGISTRY
Authors: Rafat Abonour, Robert Rifkin, Sikander Ailawadhi, Hans C. Lee, Christina Gasparetto, Lynne Wagner, Brian Durie, James Hardin, Howard Terebelo, Mohit Narang, Kathleen Toomey, Yuexin Tang, Sujith Dhanasiri, Jasmeet Anand, Edward Yu, Thomas Marshall, Liang Liu, Sundar Jagannath
Journal: HemaSphere (2023)

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: Lenalidomide (LEN) and anti-CD38 monoclonal antibody (mAb)-based regimens have become a part of standard of care for first-line treatment of patients with newly diagnosed multiple myeloma (NDMM). As new agents become available for later-line treatment, it is important to understand treatment patterns and clinical outcomes in the real-world clinical practice setting; however, data to this effect have been limited in the post-LEN/anti-CD38 mAb setting. Aims: This study analyzed treatment patterns and clinical outcomes in patients with MM previously treated with LEN and an anti-CD38 mAb in the real-world Connect® MM Disease Registry. Methods: The Connect MM Disease Registry (NCT01081028) is a large, US, multicenter, prospective observational cohort study that enrolled 3011 patients with NDMM from 2009 to 2016. This analysis used data collected from September 28, 2009 through data cutoff of September 21, 2022. Eligible patients were previously treated with LEN and an anti-CD38 mAb in the same or different lines, and had started a subsequent line of treatment (index date). Descriptive statistics summarized patient characteristics, index treatment patterns, overall response rate (ORR), and best response during the index treatment line. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan–Meier methodology. Analyses were conducted for the overall study sample and stratified by prior lines of therapy (1–3 vs 4+ prior lines). Results: A total of 232 patients were included; most (>80%) were enrolled in community settings. All patients treated with an anti-CD38 mAb used daratumumab. Median age was 69 years (range, 36–89); 85% were White, 13% were African American, and 5% were Hispanic. Around 30% had ≥1 high-risk cytogenetic factor (del 17p: 12%; t(4;14): 9%; t(14;16): 4%; 1q gain: 13%), and one third had extramedullary disease before the index date. Median time from MM diagnosis to index date was 63.5 months (range, 13.4–142.9). Two thirds of patients had 1–3 prior treatment lines. Most patients (97%) were triple-class exposed and 68.1% were refractory to LEN and an anti-CD38 mAb. The top 4 index regimens were carfilzomib/dexamethasone (Kd; 7.8%), daratumumab/pomalidomide/dexamethasone (DPd; 6.0%), elotuzumab/LEN/dexamethasone (ERd; 5.2%), and carfilzomib/cyclophosphamide/dexamethasone (KCyd; 5.2%). ORR from the index treatment line was 28.4%, with median PFS of 4.4 months and median OS of 14.2 months. Patients with fewer prior lines of treatment had improved survival. Summary/Conclusion: No clear standard of care was observed in this analysis of real-world practice patterns among patients previously treated with LEN and an anti-CD38 mAb. Overall, patients had a poor overall response and survival outcomes, highlighting the need for more effective treatment options in patients with prior exposure to LEN and an anti-CD38 mAb. Figure. Kaplan–Meier plots of PFS (A) and OS (B). OS, overall survival; PFS, progression-free survival.Keywords: Multicenter, Clinical outcome, Immunomodulation, Multiple myeloma